Provider Demographics
NPI:1982865481
Name:PATEL, HEEREN RAJESH (MD)
Entity Type:Individual
Prefix:
First Name:HEEREN
Middle Name:RAJESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E TERRA COTTA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3621
Mailing Address - Country:US
Mailing Address - Phone:815-455-2752
Mailing Address - Fax:815-455-2789
Practice Address - Street 1:750 E TERRA COTTA AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-455-2752
Practice Address - Fax:815-455-2789
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1285262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128526OtherSTATE LICENSE